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Schema Therapy Worksheet

Schema, mode and coping style for one moment

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Schema therapy works three layers at once: the schema (the old belief formed when a core childhood need went unmet), the mode you are in when it fires, and the coping style that keeps it intact. Fill this in for one recent situation that stung more than it should have.

The situation — what happened, in one or two factual lines
The feeling, and where it landed in the body
The belief that came with it, in the schema's own words ('I am…', 'people will…')
Which schema this looks like (see the checklist page)
Which mode I was in — vulnerable child, angry child, punitive parent, detached protector, overcompensator
How I coped — surrendered, avoided, or overcompensated — and what that cost
How true the belief felt in the moment
none
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most
How true it looks now, reading it back
none
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What the childhood origin of this belief probably is (roles only, no names)
What my Healthy Adult would say to the part of me that believed it
One thing I will do differently the next time this fires

References & further reading

Conceptual background and further reading, not validation of this handout. Named instruments and methods belong to their original authors; custom prompts and trackers are not validated versions of those instruments.

© 2026 TherapistAssist · For clinical use · Not a substitute for assessment
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